Provider Demographics
NPI:1770558355
Name:TAYLOR, SCOTT MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MATTHEW
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 N BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3783
Mailing Address - Country:US
Mailing Address - Phone:479-251-7000
Mailing Address - Fax:
Practice Address - Street 1:2901 E ZION RD
Practice Address - Street 2:SUITE 12
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5007
Practice Address - Country:US
Practice Address - Phone:479-251-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127764608Medicaid
AR3082OtherARKANSAS DENTAL LICENSE #
59988OtherMPIN #
AR127764608Medicaid